Dispensing (201-300 questions)

Proverbs 16:3

b. decreases oral hypoglycemic effect

Glibenclamide-thiazide diuretics interaction may result to;

a. increase potassium level

b. decreases oral hypoglycemic effect

c. platelet inhibition

d. sodium depletion

b. hyperkalemia

Concurrent administration of Enalapril and Spironolactone should be used with caution because of the risk of;

a. hypokalemia

b. hyperkalemia

c. dehydration

d. excessive CNS depression

b. beneficial synergistic combination

Sulfathiazole and Trimethoprim is a;

a. harmful antagonistic combination

b. beneficial synergistic combination

c. beneficial antagonistic combination

d. harmful synergistic combination

a. Displacement of warfarin from its protein binding sites by sulfonamides may lead to thrombosis.

---

RATIONALE:

→ Displacing warfarin ↑ free warfarin → bleeding, not thrombosis.

Which of the following statements is NOT correct?

a. Displacement of warfarin from its protein binding sites by sulfonamides may lead to thrombosis.

b. Antibiotics, by reducing the GI flora, may interrupt the enterohepatic recirculation of oral contraceptives resulting to reduction in the serum estrogen concentrations.

c. Probenecid decreases renal excretion of penicillin by blocking the active tubular secretion of the antibacterial drug.

d. Phenobarbital, antihistamine, and alcohol have additive sedative activity.

d. protein-rich food

The bioavailability of propranolol is increased if taken with;

a. coffee

b. carbohydrate-rich food

c. high-fat content meal

d. protein-rich food

c. I and III

TRUE statements regarding the effect of food/diet include;

I. Calcium ion in dairy products chelates tetracycline thus decreasing its absorption

II. Felodipine (Plendil) - plasma level is decreased by grapefruit juice

III. Plasma concentration of cetirizine and loratidine are decreased by fruit juices

a. I, II and III

b. II and III

c. I and III

d. I and II

b. hypokalemia

Aloe vera-thiazide diuretics interaction may result to;

a. increase potassium level

b. hypokalemia

c. platelet inhibition

d. sodium depletion

b. Hyperglycemia

Too rapid infusion of TPN may lead to this complication.

a. Sepsis

b. Hyperglycemia

c. Anemia

d. Hyperammonemia

a. I, II and III

Which of the following statements characterize an adverse drug reaction (ADR)?

I. a reaction that is noxious and unintended

II. may occur at doses normally used for prophylaxis, diagnosis, or therapy of disease

III. side effects and allergy are ADR

a. I, II and III

b. I and II

c. I and III

d. II and III

a. adverse drug event

Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer is termed as;

a. adverse drug event

b. medication error

c. side effect

d. anaphylaxis

c. side effect

An expected and known effect of a drug that is not the intended therapeutic outcome is termed as;

a. allergy

b. idiosyncratic reaction

c. side effect

d. hypersensitivity reaction

a. I, II and III

Patients who are more likely to experience ADR include;

I. Elderly

II. Obese and malnourished

III. With chronic disease

a. I, II and III

b. I and II

c. I and III

d. II and III

c. Taking multiple prescription medicines, OTC drugs and alternative products increase the risk of experiencing an ADR.

Which of the following statements is TRUE regarding risk factors of ADR?

a. Young adults are predisposed more to drug toxicity than elderly.

b. Female have lesser risk of developing ADR than male.

c. Taking multiple prescription medicines, OTC drugs and alternative products increase the risk of experiencing an ADR.

d. Aminoglycosides, digoxin, and theophylline ADR are attributed to genetic factors.

b. subacute

ADR may be classified according to their onset or timing of reaction. Which of these is occurring within 24 hours of drug exposure?

a. acute

b. subacute

c. latent

d. mild

b. moderate

---

• Mild → No treatment / self-limiting.

• Moderate → Requires active treatment of the adverse reaction, or further testing/evaluation to assess it. ✅

• Severe → Life-threatening, requires intensive medical intervention, or results in disability/death.

ADR may also be classified according to their severity. What class requires active treatment of adverse reaction, or further testing or evaluation to assess?

a. mild

b. moderate

c. severe

d. significant

c. within 2 or more days of exposure

A latent ADR appears;

a. within 1 hour of exposure

b. with 1 week of exposure

c. within 2 or more days of exposure

d. within 2 or more weeks of exposure

d. I, II and III

FDA defines significant ADRs as those that are;

I. Life-threatening

II. Permanently or significantly disabling

III. Require or substantially prolong hospitalization

a. I and III

b. II and III

c. I and II

d. I, II and III

b. II and III

Type F ADR or failure of therapy may be due to;

I. patient compliance

II. antimicrobial resistance

III. drug interactions

a. I, II and III

b. II and III

c. I and II

d. I and III

c. I and II

Type B ADR can be described as;

I. unrelated to the drug's pharmacological effect dependent

II. not dose dependent

III. common, predictable and less serious than Type A

a. I, II and III

b. II and III

c. I and II

d. I and III

b. III only

Idiosyncratic reactions are considered;

I. Type A

II. predictable

III. non-immunologic

a. I only

b. III only

c. I and II

d. I and III

d. Type D

Carcinogenicity is under what type of ADR?

a. Type A

b. Type B

c. Type C

d. Type D

d. Type A

Extensive sedation caused by decreased clearance of a usual dose of a benzodiazepine is an example of:

a. Type E

b. Type F

c. Type B

d. Type A

a. Type I

Anaphylaxis from a beta-lactam antibiotics is an immunologic reaction classed as:

a. Type I

b. Type II

c. Type III

d. Type IV

a. Doxurubicin

Cardiotoxicity is a delayed ADR associated with which chemotherapeutic agent?

a. Doxurubicin

b. Paclitaxel

c. Vincristine

d. Cisplatin

a. I and II

Untoward reaction linked to Chloramphenicol include:

I. Aplastic anemia

II. Gray baby syndrome

III. SLE-like syndrome

a. I and II

b. I and III

c. II and III

d. I, II, and III

c. erythema multiforme

Mrs. K experienced skin rash, which are large, deep red and look darker at the center after taking a beta-lactam antibiotic for 3 days. The ADR is suspected to be;

a. photosensitivity reaction

b. toxic epidermal necrolysis

c. erythema multiforme

d. serum sickness

c. Increase in BP

The adverse effect that may be produced by cough and cold remedies containing phenylpropanolamine is;

a. GI disturbances

b. Serum sickness

c. Increase in BP

d. Decrease in BP

b. thalidomide

---

• Phocomelia → Thalidomide

• Craniofacial/CNS defects → Tretinoin

• Fetal hydantoin syndrome → Phenytoin

• Various possible anomalies → Phenothiazines

Phocomelia is a teratogenic effect associated with the use of;

a. tretinoin

b. thalidomide

c. phenytoin

d. phenothiazines

d. II and III

NSAID's induced ADR include;

I. cardiotoxicity

II. nephropathy

III. GI ulcer

a. I, II and III

b. I and II

c. I and III

d. II and III

c. II and III

Ototoxicity or hearing loss is an ADR commonly associated with the use of;

I. Phenothiazines

II. Loop agents

III. Aminoglycosides

a. I, II, and III

b. I and III

c. II and III

d. I and II

a. Statins

Severe myopathy and rhabdomyolysis can be induced by which group of agents?

a. Statins

b. NSAIDs

c. Sulfonylureas

d. Beta-blockers

d. II and III

A drug-induced hypersensitivity reaction caused by sulfonamides:

I. Parkinson's disease

II. Steven-Johnson's disease

III. Contact dermatitis

a. I, II, and III

b. I and II

c. I and II

d. II and III

b. Malignant hyperthermia from antipsychotic

Which of the following is an idiosyncratic reaction?

a. Anaphylaxis from penicillin

b. Malignant hyperthermia from antipsychotic

c. Flushing and hypotension from Vancomycin

d. Hypoglycemia from oral sulfonylureas

a. Isoniazid

Which of the following anti-TB drugs will cause peripheral neuritis in slow acetylators?

a. Isoniazid

b. Ethambutol

c. Pyrazinamide (PZA)

d. Rifampin

d. aspirin

This analgesic-antipyretic drug should not be used in children with chickenpox or flu.

a. Paracetamol

b. ibuprofen

c. Mefenamic acid

d. aspirin

c. aspirin

Reye's syndrome has been associated with the use of which analgesic drug?

a. naproxen

b. celecoxib

c. aspirin

d. paracetamol

a. Stevens-Johnson syndrome

NOTE:

SJS is immunologic

Non-immunologic drug reactions include all of the following EXCEPT;

a. Stevens-Johnson syndrome

b. Dry mouth from antihistamines

c. Thrush while taking antibiotics

d. Hepatotoxicity from methotrexate

c. immune complex

---

• Type I : Immediate, IgE-mediated allergy

• Type II: Cytotoxic (antibody destroys cells)

• Type III: Immune complex (antigen-antibody complexes cause inflammation)

• Type IV: Delayed cell-mediated (T-cell response, delayed)

• Idiosyncratic: Unpredictable, non-immune reactions unique to the individual

Type III immunologic drug reactions is described as;

a. cytotoxic

b. idiosyncratic

c. immune complex

d. delayed cell mediated

d. allergic contact dermatitis

---

• Type I: Urticaria (immediate, IgE-mediated)

• Type II: Thrombocytopenia (cytotoxic antibody-mediated)

• Type III: Serum sickness (immune complex-mediated)

• Type IV: Allergic contact dermatitis (delayed, T-cell mediated)

An example of Type IV hypersensitivity reactions;

a. urticaria

b. thrombocytopenia

c. serum sickness

d. allergic contact dermatitis

b. hydralazine

Lupus-like syndrome is associated with which agent?

a. sulfonamides

b. hydralazine

c. anticonvulsants

d. carbamazepine

d. idiosyncratic reaction

Development of anemia with the use of anti-oxidant drugs in the presence of glucose-6 phosphate dehydrogenase deficiency is an example of;

a. intolerance

b. hypersensitivity

c. pseudo-allergic reaction

d. idiosyncratic reaction

d. hemolytic anemia

Clinical manifestations of Ig-E type immune drug reactions include all of the following EXCEPT;

a. Urticaria

b. bronchospasm

c. anaphylaxis

d. hemolytic anemia

d. II and III

Which of the following statements is CORRECT regarding conjunctival pigmentation as an ADR?

I. Phenytoin can cause this effect

II. It is the grayish-brown discoloration of the conjunctiva

III. It is dose related

a. I and II

b. I and II

c. I and III

d. II and III

d. I, II and III

ADR associated with the use of phenytoin include;

I. gingival hyperplasia

II. Steven's Johnson Syndrome

III. hirsutism

a. I and II

b. I and III

c. II and III

d. I, II and III

b. busulfan

This agent can cause pulmonary toxicity.

a. penicillin

b. busulfan

c. diethylstilbestrol

d. aspirin

b. exaggerated sun-burn like reactions

Phototoxic reactions are manifested as;

a. bright or dark red macules

b. exaggerated sun-burn like reactions

c. malaise and fever

d. erosions and hemorrhagic crusting of the lips, oral mucosa, conjunctiva, urethra and anogenital regions

c. Serum sickness

A delayed allergic response by the immune system against a large amount of foreign protein or hapten that have entered the bloodstream.

a. Anaphylactic reaction

b. Pseudo-allergic reactions

c. Serum sickness

d. Lupus-like syndrome

d. Tardive dyskinesia from antipsychotics

Type C ADR include all of the following EXCEPT;

a. Adrenal suppression due to prolonged corticosteroid administration

b. Drug dependency

c. Analgesic nephropathy

d. Tardive dyskinesia from antipsychotics

b. Type E

Opiate withdrawal is an ADR classified as;

a. Type F

b. Type E

c. Type D

d. Type C

c. secondary effect

Development of diarrhea with antibiotic therapy due to altered gastrointestinal bacterial flora is an ADR due to;

a. overdose

b. side effect

c. secondary effect

d. drug interaction

b. hepatic failure due to paracetamol

Which of the following toxicities (ADR) is due to overdosage?

a. sedation with antihistamines

b. hepatic failure due to paracetamol

c. tachycardia from albuterol

d. diarrhea from amoxicillin

b. intolerance to the dose of salicylate

NOTE:

Aspirin → tinnitus (ringing in ears) at normal/small doses = dose-related intolerance

Following a single, small dose of ASA, a patient experienced ringing on both ears. This reaction could be due to;

a. pharmacologic side effect of ASA

b. intolerance to the dose of salicylate

c. allergic reaction to ASA

d. secondary pharmacologic side effect

c. megaloblastic anemia

A drug-induced reaction associated with folate antagonist(folate blocker) is;

a. dermatologic reactions

b. serum sickness

c. megaloblastic anemia

d. cirrhosis

a. ACE inhibitor

NOTE: ARBS dapat

A patient with on stage C heart failure complains on dry, and persistent cough. Which of the drugs for Heart Failure could be implicated with the patients’ complaint?

a. ACE inhibitor

b. Beta blocker

c. Calcium channel blocker

d. Digoxin

a. I, II and III

Bronchoconstriction may be precipitated by;

I. atenolol

II. aspirin

III. tartrazine

a. I, II and III

b. II and III

c. I and II

d. I only

d. diarrhea

Which of the following is NOT an anticholinergic effect?

a. dry mouth

b. urinary retention

c. tachycardia

d. diarrhea

• Diarrhea

• Constipation

What is the side effect of [2]

• Cholinergic drug= ___ [diarrhea/constipation]?

• Anticholinergic drug = ___ [diarrhea/constipation]?

a. I, II and III

Situations or conditions that may lead to tachycardia include;

I. hypoglycemia

II. large consumption of energy beverages

III. concomitant administration of theophylline and erythromycin

a. I, II and III

b. I and III

c. I and II

d. II only

a. I, II and III

Incidence of falls and injuries are associated with the;

I. Prazosin

II. Diphenhydramine

III. Diazepam

a. I, II and III

b. I and III

c. I and II

d. II only

c. I and II

Orthostatic hypotension is common to;

I. Tricyclic Antidepressants (TCA's)

II. Phenothiazines (Antipsychotic)

III. alpha-agonists

a. I, II and III

b. I and III

c. I and II

d. III only

b. antipsychotics

Extrapyramidal effect, such as Parkinson-like reaction is commonly associated with which group of drugs?

a. antidepressants

b. antipsychotics

c. neuromuscular blockers

d. all of these

c. COMT inhibitors

Drugs that should NOT be given with levodopa include all of the following EXCEPT;

a. nonselective MAOIs

b. Pyridoxine

c. COMT inhibitors

d. Antipsychotics

d. lithium

Due to sodium depletion, diuretics increase the toxicity of;

a. digoxin

b. antigout drugs

c. oral hypoglycemic

d. lithium

b. Sympathomimetics

Severe headache, hypertensive crisis and cardiac arrhythmias are toxicities than can develop if MAOIs are taken with;

a. TCAs

b. Sympathomimetics

c. NSAIDs

d. Diuretics

c. guanethidine

TCAs can inhibit the uptake of this drug into nerve terminal resulting to reduced antihypertensive action.

a. clonidine

b. prazosin

c. guanethidine

d. captopril

a. worsens ulcer

Ergot alkaloids can;

a. worsens ulcer

b. precipitate gouty arthritis

c. induce hypothyroidism

d. aggravate psychosis

acidic

Ergot alkaloids are ____ [acidic /basic] in nature ?

c. II and III

Atropine-like reactions can be observed in;

I. Benztropine

II. Imipramine

III. Phenelzine

a. I, II and III

b. I and II

c. II and III

d. I and III

b. severe hypotension

Sildenafil is contraindicated with organic nitrates because the interaction could lead to:

a. hypertensive crisis

b. severe hypotension

c. hypokalemia

d. arrhythmias

c. opiates

---

NOTE:
Opiate overdose causes respiratory depression characteristic pin point pupil (miosis)

Except : Meperidine (mydriasis )

Respiratory depression with a characteristic pin point pupil is associated with overdosage of:

a. barbiturates

b. benzodiazepines

c. opiates

d. alcohol

• miotic

• mydriatic

• Pin point pupil = ___ [miotic/ mydriatic]

• Dilated pupil = ____ [miotic/ mydriatic]

a. androgens

Masculinization of the female fetus can result after uterine exposure to;

a. androgens

b. estrogens

c. carbamazepine

d. thalidomide

d. III only

Amphotericin B, a systemic antifungal agent is;

I. ototoxic

II. hepatotoxic

III. nephrotoxic

a. I, II and III

b. I and II

c. I only

d. III only

b. Gasping syndrome

---

• Gasping syndrome = benzyl alcohol

• Gray baby syndrome = chloramphenicol

• Reye’s syndrome = aspirin

• Cushing syndrome = too much cortisol (steroid hormone)

Newborns exposed repeatedly to benzyl alcohol, a preservative in many injectable products, may lead to a potentially fatal condition referred to as;

a. Cushing syndrome

b. Gasping syndrome

c. Gray -baby syndrome

d. Reye’s syndrome

a. Amiodarone

Drug-induced hyperthyroidism could be associated with which of the following drugs for arrhythmia?

a. Amiodarone

b. Verapamil

c. Quinidine

d. Propranolol

c. increased hepatic toxicity

Kava-kava and acetaminophen interaction may lead to;

a. increase bleeding time

b. autoimmune disease flare

c. increased hepatic toxicity

d. increase and prolong sympathomimetic effect

b. I and II

Herbal products that increase risk of bleeding include;

I. Ginkgo

II. Feverfew

III. Dong quai

a. I, II and III

b. I and II

c. II and III

d. I and III

d. Comfrey

This herb must be used in caution as it may be carcinogenic.

a. Licorice

b. Ma Huang

c. St. John’s wort

d. Comfrey

c. I and III

Asian and Siberian ginseng may be used to increase physical stamina. These herbs should be avoided by patients;

I. with hypertension

II. with autoimmune diseases

III. on warfarin therapy

a. I, II and III

b. I and II

c. I and III

d. I only

c. May interact with Selective Serotonin Reuptake Inhibitor (SSRI)

Which of the following statements is correct regarding St. John’s wort?

a. It’s safety in pregnancy is unknown

b. It is not helpful in treating mild depression

c. May interact with SSRI

d. May interact with milk and cheese

b. garlic

A patient, 32 years old has a family history of heart disease and would like to considered herbal supplement to reduce the risk of developing atherosclerosis as he aged. Which of the following could be beneficial to him?

a. saw palmetto

b. garlic

c. ginger

d. valerian

d. insulin

Garlic should be used with caution by diabetics since it may increase the release of:

a. serotonin

b. adrenaline

c. histamine

d. insulin

a. micturition difficulty

Saw palmetto is indicated for the treatment of:

a. micturition difficulty

b. cirrhosis

c. fatigue

d. convalescence

d. I, II and III

For medications requiring administration at school or day care, pharmacists should also explore problems with;

I. Dosage formulation

II. Taste or texture aversion

III. Dosing frequency

a. I only

b. II only

c. III only

d. I, II and III

d. Ma Huang

This herb is considered unsafe since it may cause Myocardial Infaction (MI) , strokes or seizures.

a. Garlic

b. Dong quai or Female Ginseng

c. Kava

d. Ma Huang

c. Milk thistle

Hepatotoxic herbs include all of the following EXCEPT:

a. Kava

b. Germander

c. Milk thistle

d. Liferoot

d. Echinacea (aka “purple cone flower”)

The patient asks the pharmacist about a supplement that could prevent colds and flu during the winter months. Which of the following could be recommended?

a. Feverfew

b. Black Cohosh

c. Ginkgo

d. Echinacea or purple cone flower

d. Category X

The classification of drug according to the degree of their potential risk during pregnancy is contraindicated in women who are or may become pregnant.

a. Category A

b. Category B

c. Category C

d. Category X

a. Category A

Classification of drug according to the degree of their potential risk during pregnancy as showed no risk in controlled studies.

a. Category A

b. Category B

c. Category C

d. Category D

b. I and III

FDA Pregnancy Category D;

I. Studies show human fetal risk

II. Contraindicated in pregnancy

III. Potential benefit in pregnant women may outweigh risk

a. I, II and III

b. I and III

c. II and III

d. II only

a. A

Etretinate, a derivative of vitamin ____, is a potent teratogen in human and should be discontinued several months before pregnancy.

a. A

b. B

c. C

d. D

a. Warfarin

The most teratogenic agent in the first trimester of pregnancy, but can also cause malformation during the second and third trimester is;

a. Warfarin

b. Finasteride

c. Ethanol

d. Phenytoin

I and III

This drug increases the risk of neural tube defects.

I. Valproic acid

II. Phenytoin

III. Carbamazepine

a. I and II

b. II and III

c. I, II and III

d. III only

d. folic acid (Vit. B9)

Neural tube defects are lowered in women who are taking;

a. ascorbic acid

b. iron

c. riboflavin

d. folic acid

a. NSAIDs

The use of these agents by pregnant women may cause ductus arteriosus to close prematurely and could result in pulmonary hypertension in newborn.

a. NSAIDs

b. anticoagulants

c. anticonvulsants

d. antineoplastics

d. Category X

Based on pregnancy risk, Tretinoin administered topically is classified as;

a. Category A

b. Category B

c. Category D

d. Category X

a. metoclopramide

This drug has been used therapeutically to enhance milk production.

a. metoclopramide

b. methyldopa

c. haloperidol

d. dicyclomine

b. I and III

FDA Pregnancy Category X drug include;

I. Rosuvastatin

II. PTU

III. Finasteride

a. I and II

b. I and III

c. II and III

d. I only

c. mottling of teeth

Tetracycline should not be used in children because it can cause;

a. neonatal apnea

b. anemia

c. mottling of teeth

d. Ebstein anomaly

c. Hydantoins

Cleft lip and cleft palate are congenital abnormalities associated with the use these agents during pregnancy.

a. Alcohol

b. Cigarette smoking

c. Hydantoins

d. Lithium